Neurophysiological techniques and computerized visual field for early detection of centraln ervous system involvement in systemic lupus erythematosus

Abstract EN

Central nervous system involvement is common in systemic lupus erythematosus (SLE).

But in early cases, sophisticated tests as nuclear magnetic resonance, computerized tomography, and cerebrospinal fluid antibodies have shown relative insensitivity.

Objective: The purpose of this prospective case control study was to determine the subclinical central nervous system involvement in systemic lupus erythematosus using some electrophysiological techniques on 41 systemic lupus erythematosus patients and 30 age and sex matched controls.

Methods: We performed clinical and laboratory tests including: L.E.

cells, serum antinuclear antibodies, Anti-dsDNA, ophthalmological techniques: including the use of computerized visual field and neurophysiological investigations including visual evoked potentials (VEPs) and brain auditory evoked potentials (BAEPs).

Results: Twenty-five patients (61%) had abnormal VEPs despite the absence of any clinical, central or peripheral neurological manifestations.

Computerized visual field examination showed central or centrocaecal scotoma in only 29.3% of the cases.

This suggested that VEP is much more sensitive for detection of optic nerve involvements than computarized visual field testing (p<0.001).

Twenty-eight (68.3%) patients of our group presented with abnormal prolongation of absolute wave latencies of different waveforms of BAEPs.

Also there was a significant prolongation of interpeak latencies (IPLs) compared to controls.

VEPs and BAEPs did not show any significant correlation to any clinical or laboratory data except for the presence of LE cells that proved to be related to IPLs of BAEPs, and anti-dsDNA levels, which in turn proved to be correlated to some neurophysiological parameters (P100 latencies and III-V interpeak latencies).

Conclusion: Therefore, we suggest performing VEPs and BEAPs studies for identification any occult CNS disorders in SLE patients as they are sensitive measures to ischemic changes, even in neurologically asymptomatic patients.